MUSCULOSKELETAL INFECTIONS

Osteomyelitis

Osteomyelitis in an infection of the bone that results in inflammation, necrosis, and

formation of new bone.
Frequency
United States
The overall prevalence is 1 case per 5,000 children. Neonatal prevalence is
approximately 1 case per 1,000. The annual incidence in patients with sickle cell
anemia is approximately 0.36%. The prevalence of osteomyelitis after foot puncture
(as is seen in the image below) may be as high as 16% (30-40% in patients with
diabetes). The incidence of vertebral osteomyelitis is approximately 2.4 cases per
100,000 population.

Mortality/Morbidity
Morbidity can be significant and can include localized spread of infection to
associated soft tissues or joints; evolution to chronic infection, with pain and
disability; amputation of the involved extremity; generalized infection; or sepsis. As
many as 10-15% of patients with vertebral osteomyelitis develop neurologic findings
or frank spinal-cord compression. As many as 30% of pediatric patients with long-
bone osteomyelitis may develop deep venous thrombosis (DVT). The development of
DVT may also be a marker for disseminated infection.Vascular complications appear
to be more common with community-acquired methicillin-resistant Staphylococcus
aureus (CA-MRSA) than was previously recognized

• Classification
1. Hematogenous osteomyelitis- due to bloodborne-spread infection.
2. Contiguous-focus osteomyelitis- from contamination from bone surgery,
open fracture, or traumatic surgery.
3. Osteomyelitis with vascular insufficiency- seen most commonly among
patients with diabetes and peripheral vascular disease, most commonly
affecting the feet.

• Causes
Age group Most common organisms
Newborns (younger than 4 S. aureus, Enterobacter species, and group A and B
mo) Streptococcus species
S. aureus, group A Streptococcus species, Haemophilus
Children (aged 4 mo to 4 y)
influenzae, and Enterobacter species
Children, adolescents (aged S. aureus (80%), group A Streptococcus species, H.
4 y to adult) influenzae, and Enterobacter species
S. aureus and occasionally Enterobacter or Streptococcus
Adult
species

Sickle Cell Anemia Patients Salmonella species

• Risk Factors
1. Poor Nurishment
2. Elderly
3. Obese
4. Patients with impaired immune system and with chronic illnesses.
5. Immunocompromized patient.

• Clinical Manifestations
1. Chills
2. High Fever
3. Rapid Pulse
4. General Malaise
5. Pain, swelling and tenderness in affected areas
6. nonhealing ulcer that overlies the infected bone with a connective sinus
that will intermittently and spontaneously drain pus.
• Pathophysiology